I recently got hired at my first nursing job which is a ltc facility. I an extremely overwhelmed and want to go and find another job. The most confusing think about it is the system for passing meds. Unfortunately this facility is still living in the 80’s and still uses paper for everything. The mar is a binder you carry around all day on the med cart with over 1000 pages many of them are ripped out or hanging on by a tread. I am having a hard time adjusting too it. I also asked for a list of policies and was told the policies are scattered all over in the nursing station in many of the file cabinets
In the nursing school that i attended everything was all digital. To top it off i work 3-11 were we are short staffed so i am constantly watching the first door to make sure a resident doesn't escape because we do not have overnight security or a nursing supervisor.
The nursing patio ratio ranges anywhere between 25-32. Can anyone give me any suggestions on learning how pass meds with a paper mar. I witness two nurses administer the wrong meds because of this system. Most of our patients have dementia and do have wrist bands and the mar is missing pictures of them. I asked the staff several times for help and they all seem to brush it off because many of them have been there for 20 years and know all the patients.
With 30 residents, you cannot create your own worksheet and list ALL of the med times. You can use a worksheet, however, to organize your fingersticks, charting, treatments and things like that.
When I worked the floor, I never had photos of my residents. The armband is their ID and if you keep working on the same unit, you WILL get to know them all. Some nurses I worked with used to mark the MAR somehow (sticky notes, for example) to indicate the resident had meds to give on the next med rounds - to prevent having to flip through EVERY piece of paper at every med admin time.
It seems like an impossible task at first, but you will get more efficient as time goes on. It sounds like the MAR papers need those sticker reinforcements where the hole punch is, to keep it from falling apart. Since they are used for a whole month, they are definitely chewed up by the end!
Good Luck!
Thank you. They don't wear arm band at all. Not even for DNR because of HIPA. And most of them have dementia so it is difficult to know who is who without the photographs. Many of them end up in the wrong beds.
Thank you. They don't wear arm band at all. Not even for DNR because of HIPA. And most of them have dementia so it is difficult to know who is who without the photographs. Many of them end up in the wrong beds.
Oh gosh. I would question your supervisor about how you are supposed to check the rights of medication administration without proper identification. It doesn't matter if the nurse "knows" the resident. During survey, they could cite you for med errors for each resident that cannot be identified.
Also i want to add is it normal for an ltc facility to only count narcotic medication ? For example we have a draw full otc bottles of meds like Tylenol vitamins etc and we also have 30 med cards with meds like flomax, lasix, carbidopa/levodopa and metoprolol that aren’t counted ever during the shift. Is this normal/ safe ?
Yes, It is normal. To answer your other question about getting your rythm down. LTC's and STR's usually have med passes that are at a certain times. If you work days it would be at 9,12 and 2pm. The evening shift is usually 6 and 9pm. I worked in a facility once that had 25-30 pts and the med pass would take the day nurse 3 hrs, that nurse had poor time management skills. this means that its impossible to spend the amount of time that you you like to with every patient. You will really need to rely on your CNA's, good ones are so crucial to nurses being able to keep it moving.
Oh gosh. I would question your supervisor about how you are supposed to check the rights of medication administration without proper identification. It doesn't matter if the nurse "knows" the resident. During survey, they could cite you for med errors for each resident that cannot be identified.
Will do. Believe it or not the senior nurses don't even perform the checks or use the mar many of them go off of memory. I got laughed at for asking about the med checks before administering
Yes, It is normal. To answer your other question about getting your rythm down. LTC's and STR's usually have med passes that are at a certain times. If you work days it would be at 9,12 and 2pm. The evening shift is usually 6 and 9pm. I worked in a facility once that had 25-30 pts and the med pass would take the day nurse 3 hrs, that nurse had poor time management skills. this means that its impossible to spend the amount of time that you you like to with every patient. You will really need to rely on your CNA's, good ones are so crucial to nurses being able to keep it moving.
I wish it was this simple. The med times are just about every 2 hours or less for some. Couple of hospice pts require hourly morphine. Blood sugars at 4 and 8. Carbidopa every 2 hours, bolus gtube feeding, breathing treatments etc.
Will do. Believe it or not the senior nurses don't even perform the checks or use the mar many of them go off of memory. I got laughed at for asking about the med checks before administering
I wish it was this simple. The med times are just about every 2 hours or less for some. Couple of hospice pts require hourly morphine. Blood sugars at 4 and 8. Carbidopa every 2 hours, bolus gtube feeding, breathing treatments etc.
It is simple, I learned it and so can you. You need to combine some of the due times to make the med pass manageable. If you have meds due at 11/12/1 do the med pass at 12 and give them at one time, its ok if some are a little early and some are a little late. Remember you can give meds an hour before and up to an hour after due times. If you have meds due at 5/6/7 due med pass at 6, then you get to take care of all 3 at once. Its about being efficient with time management.
Like I said before...you will not get as much time with the patients as you thought you would, like in nursing school. In nursing school most of us only had up to 2-3 patients, now you have 20-30 patients. Time management and prioritizing is key!
Well, I could have wrote this story about 2 years ago. My first job was ltc. Unfortunately everything you've described is pretty much the norm. Too many meds, patients, treatments ,ect. Workarounds were everywhere. People signing for treatments and meds they didn't give or do. No way to id patients. We had pics in the mar, some I kid you not were so dark they were just shadows. I know you have to get your foot in the door and get that first job but don't stay long enough so that you pick up these bad habits. Get a little experience and move on asap like many do. I don't want to discourage you but l don't want to suger coat it either.
It is simple, I learned it and so can you. You need to combine some of the due times to make the med pass manageable. If you have meds due at 11/12/1 do the med pass at 12 and give them at one time, its ok if some are a little early and some are a little late. Remember you can give meds an hour before and up to an hour after due times. If you have meds due at 5/6/7 due med pass at 6, then you get to take care of all 3 at once. Its about being efficient with time management.
Like I said before...you will not get as much time with the patients as you thought you would, like in nursing school. In nursing school most of us only had up to 2-3 patients, now you have 20-30 patients. Time management and prioritizing is key!
Thank you i will definitely try my best. I utilized a spreadsheet today.
Well, I could have wrote this story about 2 years ago. My first job was ltc. Unfortunately everything you've described is pretty much the norm. Too many meds, patients, treatments ,ect. Workarounds were everywhere. People signing for treatments and meds they didn't give or do. No way to id patients. We had pics in the mar, some I kid you not were so dark they were just shadows. I know you have to get your foot in the door and get that first job but don't stay long enough so that you pick up these bad habits. Get a little experience and move on asap like many do. I don't want to discourage you but l don't want to suger coat it either.
Thank you many people i have spoken to told me to leave after 3 months. Thats if i can withstand it. I have gotten other offers at different places.
Lovethenurse2b25, ASN, BSN, CNA, LPN, RN
343 Posts
Thank you. They don't wear arm band at all. Not even for DNR because of HIPA. And most of them have dementia so it is difficult to know who is who without the photographs. Many of them end up in the wrong beds.